Loan Application

Please print this application and mail or FAX it to the credit union.

How to       Complete all sections
Apply         Sign on the signature line
                   Return completed form to credit union
                   An incomplete or unsigned form may delay processing

Credit Card Disclosures

Annual Percentage
Rate of Purchases

Grace Period for Repayment of the Balance for Purchases

Method of Computing the Balance for Purchases

Minimum Finance Charge

Transaction Fees for Purchases

Annual Fee

Other Fees

16.0%

25days

Average Daily Balance
(including new purchases)

$0.50

NONE

Over the Credit Limit Fee: $20.00
Late payment Fee:
$15.00, if 10 or more days late.

14.9%
(Preferred)

The information about the cost of the card described above is accurate as of 11/98. This information may have changed after that date. To find out what may have changed you may write to us at PO Box 26364, Jacksonville, FL 32226 or call us at (904) 757-5562.

Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:
1. you live in or the property pledged as collateral is located in a community property state
( AZ, CA, ID, LA, NM, NV, TX, WA, WI ),
2. your spouse will use this account, or
3. you are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to extent possible about the person on whose payments you are relying.
Joint Credit: If you are applying with another person, complete the Applicant and Other sections.

Check below to indicate the type of account(s) and type of credit for which you are applying. Married Applicants may apply for a separate account.

LOANLINERŽ Account/Loan: Individual Joint (including ATM/Debit Card Access to the Account if Available) Amount Requested $_____________________________ Purpose/Collateral: ______________________________ Repayment: Payroll Deduction Cash Military Allotment	Credit Card Account: Individual Joint (See Disclosure Table or Agreement for Terms) Credit Limit Requested $_________________________ If Authorized User, Name: ______________________ Automatic Payment Other ______________
Applicant.	Other: Co-Applicant Spouse

Name (Last - First - Initial)		Mother's Maiden Name		Name (Last - First - Initial)		Mother's Maiden Name
Account Number		Social Security Number		Account Number		Social Security Number
Driver's License Number / State				Driver's License Number / State
Birth Date Home Phone Business Phone/ Ext. ( ) ( )				Birth Date Home Phone Business Phone/ Ext. ( ) ( )
Present Address (Street - City - Zip)		Own Rent Years at this Address		Present Address (Street - City - Zip)		Own Rent Years at this Address
Mortgage/Rent Owed To:				Mortgage/Rent Owed To:
Mortgage Balance $	Monthly Payment $		Interest Rate %	Mortgage Balance $	Monthly Payment $		Interest Rate %
Complete for Joint Credit, Secured Credit or if you live in a Community Property State: Married Separated Unmarried (Single - Divorce -Widowed)				Complete for Joint Credit, Secured Credit or if you live in a Community Property State: Married Separated Unmarried (Single - Divorce - Widowed)
Employment/Income Name and Address of Employer				Employment/Income Name and Address of Employer
Notice: Alimony,Child support, or separate maintenance income need not be revealed if you do not choose to have it considered.				Notice: Alimony,Child support, or separate maintenance income need not be revealed if you do not choose to have it considered.
Employment Income Other Income $ ____________per __________ $_________ per ______ NET GROSS SOURCE				Employment Income Other Income $ ____________per __________ $_________ per ______ NET GROSS SOURCE
Reference Relationship Name and Address of Nearest Relative Home Phone Not Living with You.				Reference Relationship Name and Address of Nearest Relative Home Phone Not Living with You.

State Law Notices
OHIO RESIDENTS ONLY: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.
Wisconsin Residents Only: (1) No provision of any marital property agreement, unilateral statement under §766.59, or court decree under §766.70 will adversely affect the right of the Credit Union unless the Credit Union is furnished a

copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.

_________________________________________________
Signature for Wisconsin Residents Only DATE

Signatures

1. You promise that everything you have stated in this application is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and any update, renewal or extension of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or sate charted credit unions insured by NCUA.

2. You have received and read the LOANLINERŽ Credit and Security Agreement, including the Addendum ("Agreement"), and a Credit Insurance Certificate. By signing below you agree to be bound by the terms of the Agreement.

(Seal)

APPLICANT'S SIGNATURE DATE

3. If you are applying for a credit card, you understand that use of your credit card will constitute acknowledgement of receipt and agreement to the terms of the credit card agreement and disclosures.

4. You grant us a security interest in all individual and joint share and/or deposit accounts you have with us now and in the future to secure what you owe under the Agreement and if you have applied for a credit card, under the credit card agreement. When you are in default, you authorize us to apply the balance in these accounts to any amounts due. Share and deposits in an Individual Retirement Account, and any other account that would lose special tax treatment under state or federal law if given as security, are not subject to the security interest you have given in your shares and deposits.

(Seal)

OTHER SIGNATURE DATE

Credit Insurance

Application/ Schedule

CUNA Mutual Insurance Society * Madison, WI 53701-0391 * 800/937-2644

"You" or "Your" means the member and the joint insured (if applicable).

Credit insurance is voluntary and not required in order to obtain this loan. You may select any insurer of your choice. You can get this insurance only if you check the "yes" box below and sign your name and write in the date. The rate you are charged for the insurance is subject to change. You will receive written notice before any increase goes into effect. You have the right to stop this insurance by notifying your credit union in writing. Your signature below means you agree that:

* If you elect insurance, you authorize the credit union to add the charges for insurance to your loan each month.

* You are eligible for disability insurance only if you are working for wages or profit for 25 hours a week or more a week on the date of advance. If you are not, that particular advance will not be insured until you return to work. If you are off work because of temporary layoff, strike or vacation, but soon to resume, you will be considered at work.

* You are eligible for insurance up to the Maximum Age for insurance. Insurance will stop when you reach that age.

NOTE: The life and disability Insurance contains certain benefit exclusions, including a pre-existing condition exclusion. Please refer to your certificate for details.

You elect the following Insurance Coverage(s)						Cost per $100 of your monthly loan balance.	Covered Member (Please Print)
Single Credit Disability	YES				NO	16˘

Single Credit Life	YES		NO		6˘
Joint Credit Life		YES	NO	9˘

Any person who knowingly and with intent to injure, defraud, or deceive any insure files a statement of claim or application containing false, incomplete,or misleading information is guilty of a felony of the third degree.

If you are totally disabled for more than 14 days, then the disability benefit will begin with the 15th day of disability.

Account Number	Insurance Maximums Disability Life
Account Number	Max. Monthly Total Disability Benefit $ 750 N/A
Secondary Beneficiary (if you desire to name one)	Max. Total Disability Benefit Per Loan $50,000 N/A
	Max. Benefit Disability Duration 60 Mo. N/A
	Max. Amount of Life Insurance Per Member N/A $50,000
	Max. Age for Insurance 67 72

Date Borrower's Date of Birth	Date Co- Borrower's Date of Birth

Signature of Borrower Eligible to be Insured (Be sure to check the boxes above)	Signature of Joint Insured (Co-Borrower) (Only required if Joint Credit Life coverage is selected)

For Credit Union Use Only
Date	Approved	Approved Signature Line of Credit	Other Other Debt Ratio/Score
		$ $	$ $
	Denied (Adverse Action Notice Sent)

Loan Officer Comments:
Signatures: X	X
Date: Date: